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1972565042

NPI Code Detail

MEDICARE: JOSEPH G BANACH PT

MEDICARE: JOSEPH G BANACH PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00353317	OTHER	WA	RAILROAD MEDICARE
5	G8872200	OTHER	WA	MEDICARE
13	P00473355	OTHER	WA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2250BA	OTHER	WA	REGENCE
2	911745305-98053-A005	OTHER	WA	TRICARE
4	0232276	OTHER	WA	LABOR & INDUSTRIES
6	7312449	OTHER	WA	AETNA
7	8939859	OTHER	WA	L & I CRIME VICTIMS
8	0275625	OTHER	WA	L&I
9	0192795	OTHER	WA	DEPT. OF LABOR & INDUSTRY
10	5303BA	OTHER	WA	REGENCE BLUE SHIELD
11	8340622	OTHER	WA	DSHS
12	9847BA	OTHER	WA	REGENCE BLUE SHIELD
14	0693BA	OTHER	WA	REGENCE

General Provider Information

NPI Number	:	1972565042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH G BANACH PT

Provider Business Mailing Address
First Line	:	1519 132ND ST SE
Second Line	:	SUITE A
City	:	EVERETT
State	:	WA
Zip	:	98208-7203
Country	:	US
Telephone Number	:	425-330-0633
Fax Number	:	425-338-9637

Provider Business Practice Location Address
First Line	:	22500 NE MARKETPLACE DR
Second Line	:	SUITE 204
City	:	REDMOND
State	:	WA
Zip	:	98053-2033
Country	:	US
Telephone Number	:	425-836-1034
Fax Number	:	425-836-1037

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	01/25/2012

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Directions to “ JOSEPH G BANACH PT” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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